Review of clinical practice guidelines for hypoparathyroidism

Abstract

Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.

Parameters of Vitamin D Metabolism in Patients with Hypoparathyroidism

“…Almost three-quarters of the included patients had 25(OH)D 3 levels in the target range (>30 ng/mL), which is slightly higher than the data from the federal registry [21,22] and consistent with some of the previous studies in hypoparathyroidism [23], though some of the studies showed higher levels of 25(OH)D [24]. It is worth noting that the recommended doses of cholecalciferol differ in the guidelines for the general population [17,18] and HypoPT patients [14,25]. The guidelines for HypoPT patients recommend cholecalciferol supplementations in a daily dose of 400-800 IU to the patients treated with activated vitamin D which, given our results, may not be enough to achieve the target range and may need to be revised.…”

“…Thus, we assume that the abnormality of vitamin D metabolism does not interfere with the achievement of hypoparathyroidism compensation. We also found that magnesium levels were lower in nc-HypoPT, which highlights the importance of monitoring this parameter according to clinical guidelines [14,25].…”

“…This exploratory study included 38 adult patients with chronic HypoPT admitted for inpatient treatment at a single federal tertiary care center between 2016 and 2022. The diagnosis of HypoPT was established according to the guidelines [14]. The patients were further assigned to compensated (c-HypoPT, n = 13) and non-compensated (nc-HypoPT, n = 25) groups; the compensated state was defined as albumin-adjusted calcium 2.1-2.3 mmol/L and no symptoms of hypocalcemia.…”